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Defense, VA Expand Work on Traumatic Brain Injuries

By Lisa DanielAmerican Forces Press Service

WASHINGTON, May 5, 2010  The departments of Defense and Veterans Affairs have greatly expanded care for servicemembers and veterans with traumatic brain injuries from the battlefield after they’re discharged from rehabilitation centers, officials said today.

Air Force Col. (Dr.) Michael Jaffee, director of the Defense and Veterans Brain Injury Center, and Dr. Lucille Beck, chief consultant with VA’s Office of Rehabilitation Services, testified before the Senate Veterans’ Affairs Committee on progress in brain injury diagnosis and treatment since Congress passed a 2007 law for the departments to work together to enhance treatment.

A “highly collaborative and fruitful relationship” between the two departments has spawned comprehensive care for improvements in research, prevention, early detection, treatment and outreach, Jaffee said.

The Defense Department has made important contributions in the ongoing understanding of brain injuries, Jaffee said, and has received several awards for its randomized-controlled clinical trials and contributions to medical literature.

Also, the department has improved prevention of TBI with its continued development of protective equipment, including a next-generation combat helmet still in production, he said.

To improve early detection, the Defense Department has increased its mandatory concussion screenings to four levels, which begin as close to the time of injury as possible, and also include proposed guidelines for mandatory evaluation of all servicemembers involved in incidents considered at risk for concussions, Jaffee said.

The department has improved treatment by publishing clinical practice guidelines for TBI that recognize the common co-existing conditions of post-traumatic stress disorder and substance abuse, and created an electronic consultation service to help medical providers downrange, he said.

Brain Injury Center officials have worked with their VA counterparts to contract civilian organizations to serve patients through the Assisted Living for Veterans with TBI project at nine state-owned facilities, Jaffee said.

The VA Polytrauma/TBI System of Care, Beck said, consists of four rehabilitation centers, 22 network sites, 82 support clinic teams, and 48 points of contact devoted to multiple blast-related injuries.

The system strongly advocates family involvement, Beck said, and offers multiple levels of clinical, psychosocial, and logistical support to ensure a smooth transition and continuous care for patients and their families. VA case managers are assigned to every patient – with each case manager maintaining six cases at a time – and case managers can be reached 24 hours per day, seven days per week, she said.

VA treated 1,736 patients with severe brain injuries between March 2003 and December 2009, Beck said. Of those, 879 were active duty servicemembers, and 736 were injured in Iraq or Afghanistan, she said.

The Defense Department has identified more than 134,000 servicemembers with TBI since January 2003, most of which were mild, Jaffee said. Nearly 90 percent have completely recovered within days or weeks of the injury, he said.

Hawaii Sen. Daniel K. Akaka III, the committee chairman, said some 360,000 servicemembers are believed to have suffered brain injuries during service in Iraq and Afghanistan. Akaka said he has been impressed with the polytrauma centers and wants to create more to ease the burden on families who travel far from home to be with servicemembers needing care.

The hearing occurred just hours before President Barack Obama signed a bill, which Akaka wrote, that increases support to families of injured servicemembers and veterans so that many who otherwise would need institutional care can remain at home.